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PLATINO ALCANCE (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PLATINO ALCANCE (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PLATINO ALCANCE (HMO D-SNP) in 2025, please refer to our full plan details page.
PLATINO ALCANCE (HMO D-SNP) is a HMO D-SNP plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Puerto Rico. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that PLATINO ALCANCE (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
PLATINO ALCANCE (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PLATINO ALCANCE (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For PLATINO ALCANCE (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $15.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3650.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The PLATINO ALCANCE (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, the plan covers the cost of your prescriptions. This plan provides coverage during the initial coverage phase, and then moves to the catastrophic coverage phase once your total drug costs reach $2000. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The PLATINO ALCANCE (HMO D-SNP) plan offers a range of benefits with no copay for ambulance, emergency, and home health services. The plan also covers primary care, vision, dental, hearing, and home infusion services. Additional covered services include transportation for health-related needs and over-the-counter items up to $70 every three months. However, some services like cardiac rehabilitation, and additional days for certain inpatient and skilled nursing services are not covered.
Inpatient Hospital See details
The PLATINO ALCANCE (HMO D-SNP) plan covers Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with additional days for Inpatient Hospital-Acute being covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, with prior authorization required for outpatient hospital services, observation services, and ambulatory surgical center (ASC) services. Outpatient substance abuse services are partially covered; individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the PLATINO ALCANCE (HMO D-SNP) plan, with no copay or coinsurance for all ambulance services, but ground and air ambulance services are not covered. Transportation Services - Any Health-related Location is covered for up to 28 one-way trips per year, using taxi, rideshare services, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the PLATINO ALCANCE (HMO D-SNP) plan with no copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The PLATINO ALCANCE (HMO D-SNP) plan covers primary care physician services, chiropractic services (5 visits per year), occupational therapy, physician specialist services, podiatry services (4 visits per year), other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health specialty services and individual and group sessions for psychiatric services are not covered.
Preventive Services See details
Preventive Services are covered, but annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, and home and bathroom safety devices and modifications are not covered. The plan covers alternative therapies with 12 visits, nutritional/dietary benefits with 12 individual sessions, and counseling services.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, and prescription hearing aids with a maximum plan benefit of $1750 per year. Prescription hearing aids (all types) are covered, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers vision services, including routine eye exams once per year, and other eye exam services. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $500 per year.
Dental Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers a range of dental services, including Medicare Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery. Maxillofacial Prosthetics and Orthodontics are not covered. The plan has a maximum benefit coverage of $2750.00 every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin and Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the PLATINO ALCANCE (HMO D-SNP) plan. There is no information about the cost of this benefit.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit, both with no copay and no coinsurance, but some sub-services are not covered. Diabetic Equipment benefits are also covered, but the plan limits diabetic supplies and services to those from specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the PLATINO ALCANCE (HMO D-SNP) plan, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the PLATINO ALCANCE (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PLATINO ALCANCE (HMO D-SNP) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The PLATINO ALCANCE (HMO D-SNP) plan covers acupuncture with a limit of 12 treatments per year, and it covers over-the-counter (OTC) items, up to $70 every three months, including nicotine replacement therapy and Naloxone. Other services such as meal benefits, and several additional services are not covered.
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